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A WHO guide for planners, implementers and managers
Annexes
Annex 1
 
Declaration of Alma-Ata (1978) 
(66)
The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September 
in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, 
all health and development workers, and the world community to protect and promote the health of all the 
people of the world, hereby makes the following declaration:
I The Conference strongly reaffirms that health, which is a state of complete physical, mental and social 
wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that 
the attainment of the highest possible level of health is a most important world-wide social goal whose 
realization requires the action of many other social and economic sectors in addition to the health sector. 
II The existing gross inequality in the health status of the people, particularly between developed and 
developing countries, as well as within countries is politically, socially and economically unacceptable and 
is, therefore, of common concern to all countries. 
III Economic and social development, based on a New International Economic Order, is of basic importance 
to the fullest attainment of health for all and to the reduction of the gap between the health status of the 
developing and developed countries. The promotion and protection of the health of the people is essential 
to sustained economic and social development and contributes to a better quality of life and to world 
peace. 
IV The people have the right and duty to participate individually and collectively in the planning and 
implementation of their health care. 
V Governments have a responsibility for the health of their people which can be fulfilled only by the 
provision of adequate health and social measures. A main social target of governments, international 
organizations and the whole world community in the coming decades should be the attainment by all 
peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and 
economically productive life. Primary health care is the key to attaining this target as part of development 
in the spirit of social justice. 
VI Primary health care is essential health care based on practical, scientifically sound and socially acceptable 
methods and technology made universally accessible to individuals and families in the community through 
their full participation and at a cost that the community and country can afford to maintain at every stage 
of their development in the spirit of self-reliance and self-determination. It forms an integral part both of 
the country’s health system, of which it is the central function and main focus, and of the overall social 
and economic development of the community. It is the first level of contact of individuals, the family and 
community with the national health system bringing health care as close as possible to where people live 
and work, and constitutes the first element of a continuing health care process. 
VII Primary health care: 
1. reflects and evolves from the economic conditions and sociocultural and political characteristics of the 
country and its communities and is based on the application of the relevant results of social, biomedi-
cal and health services research and public health experience;

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Integrating palliative care and symptom relief into primary health care
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2. addresses the main health problems in the community, providing promotive, preventive, curative and 
rehabilitative services accordingly;
3. includes at least: education concerning prevailing health problems and the methods of preventing and 
controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water 
and basic sanitation; maternal and child health care, including family planning; immunization against 
the major infectious diseases; prevention and control of locally endemic diseases; appropriate treat-
ment of common diseases and injuries; and provision of essential drugs;
4. involves, in addition to the health sector, all related sectors and aspects of national and community 
development, in particular agriculture, animal husbandry, food, industry, education, housing, public 
works, communications and other sectors; and demands the coordinated efforts of all those sectors;
5. requires and promotes maximum community and individual self-reliance and participation in the plan-
ning, organization, operation and control of primary health care, making fullest use of local, national 
and other available resources; and to this end develops through appropriate education the ability of 
communities to participate;
6. should be sustained by integrated, functional and mutually supportive referral systems, leading to the 
progressive improvement of comprehensive health care for all, and giving priority to those most in 
need;
7. relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries 
and community workers as applicable, as well as traditional practitioners as needed, suitably trained 
socially and technically to work as a health team and to respond to the expressed health needs of the 
community. 
VIII All governments should formulate national policies, strategies and plans of action to launch and 
sustain primary health care as part of a comprehensive national health system and in coordination with 
other sectors. To this end, it will be necessary to exercise political will, to mobilize the country’s resources 
and to use available external resources rationally. 
IX All countries should cooperate in a spirit of partnership and service to ensure primary health care for all 
people since the attainment of health by people in any one country directly concerns and benefits every 
other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis 
for the further development and operation of primary health care throughout the world. 
X An acceptable level of health for all the people of the world by the year 2000 can be attained through 
a fuller and better use of the world’s resources, a considerable part of which is now spent on armaments 
and military conflicts. A genuine policy of independence, peace, détente and disarmament could and should 
release additional resources that could well be devoted to peaceful aims and in particular to the acceleration 
of social and economic development of which primary health care, as an essential part, should be allotted its 
proper share. The International Conference on Primary Health Care calls for urgent and effective national and 
international action to develop and implement primary health care throughout the world and particularly in 
developing countries in a spirit of technical cooperation and in keeping with a New International Economic 
Order. It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral 
and bilateral agencies, nongovernmental organizations, funding agencies, all health workers and the whole 
world community to support national and international commitment to primary health care and to channel 
increased technical and financial support to it, particularly in developing countries. The Conference calls on 
all the aforementioned to collaborate in introducing, developing and maintaining primary health care in 
accordance with the spirit and content of this Declaration. 

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